At a Glance

Why Get Tested?

When to Get Tested?

When a doctor suspects RA in someone who has jointinflammation with symptoms that suggest but do not yet meet the criteria of RA

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

None

The Test Sample

What is being tested?

Cyclic citrullinated peptide antibodies are autoantibodies produced by the immune system that are directed against cyclic citrullinated peptides (CCP). Citrulline is naturally produced in the body as part of the metabolism of the amino acid arginine. However, in some proteins, the conversion of arginine to citrulline leads to production of structures that form a ring called cyclic citrullinated peptide. This alteration and the production of CCP antibodies often occur in people who have rheumatoid arthritis (RA). There is speculation that the formation of CCP may play a role in the autoimmune inflammatory process seen in the joints of those with RA. The CCP antibody test detects and measures CCP antibodies in the blood to help diagnose RA.

RA is a chronic, systemicautoimmune disease that causes inflammation, pain, stiffness, and destructive changes in the hands, feet, and other joints throughout the body. It can affect anyone at any age, but it usually develops between the ages of 40 and 60, and about 75% of those affected are women. The course of RA and its prognosis are variable. It may develop and progress slowly or rapidly. It may go into remission in some people and, in a few, it may go away. Left untreated, RA can shorten a person's lifespan and can, within a few years, leave many of those affected too disabled to work.

There are a variety of treatments available to minimize the complications of RA, but they depend on making an accurate diagnosis and on beginning treatment before the development of significant joint damage. Rheumatoid factor (RF) has been the primary blood test used to detect RA and distinguish it from other types of arthritis and other inflammatory processes. However, the sensitivity and specificity of RF are not ideal; it can be negative in people who have clinical signs of RA and positive in people who do not. Studies have shown that the CCP antibody test has a sensitivity and specificity that is equal to or better than RF and is more likely to be positive with early RA.

The 2010 Rheumatoid Arthritis Classification Criteria from the American College of Rheumatology (ACR) includes CCP antibody testing, along with RF, as part of its criteria for diagnosing rheumatoid arthritis. According to the ACR, CCP antibodies may be detected in about 50-60% of people with early RA, as early as 3-6 months after the beginning of symptoms. Early detection and diagnosis of RA allows doctors to begin aggressive treatment of the condition, minimizing the associated complications and tissue damage.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

Is any test preparation needed to ensure the quality of the sample?

The Test

How is it used?

A cyclic citrullinated peptide (CCP) antibody test may be ordered along with or following a rheumatoid factor (RF) test to help diagnose rheumatoid arthritis (RA) and to assess the severity and probable course of the disease (prognosis). CCP antibody may also be ordered to help evaluate the likely development of RA in people with undifferentiated arthritis – those whose symptoms suggest but do not yet meet the American College of Rheumatology (ACR) criteria for RA. According to ACR, approximately 95% of those with a positive CCP antibody will meet the criteria of RA in the future.

When is it ordered?

A CCP antibody test is primarily ordered along with an RF test when someone has signs and symptoms that may be due to previously undiagnosed inflammatory arthritis or has been diagnosed with undifferentiated arthritis. It may be ordered as a follow-up test to a negative RF test when clinical signs and symptoms lead the doctor to suspect RA. RA usually affects multiple joints symmetrically. Signs and symptoms may include:

What does the test result mean?

When people with signs and symptoms of arthritis are positive for both CCP antibody and RF, it is very likely that they have RA and it is likely that they may develop a more severe form of the disease. When people are positive for CCP antibody but not RF, or have low levels of both, and have clinical signs that suggest RA, then it is likely that they have early RA or that they will develop RA in the future.

When individuals are negative for CCP antibody but have a positive RF, then the clinical signs and symptoms are more vital in determining whether they have RA or some other inflammatory condition. When someone is negative for both CCP antibody and RF, then it is less likely that they have RA. It must be emphasized, however, that RA is a clinical diagnosis and may be made in the absence of positive tests for autoantibodies.

Common Questions

1. Should everyone be tested for CCP antibody?

No. CCP antibody is not recommended as a screening test. Like RF, it is best used to evaluate individuals whose clinical signs suggest RA or who have already been diagnosed with undifferentiated arthritis.

3. Will my CCP antibody ever go away?

4. What other tests might my doctor order in evaluating me for RA?

Your doctor may choose to order an ESR and/or CRP, tests that detect inflammation. He may also order a CBC to check for a high white blood cell count, another sign of inflammation and to check for anemia, a condition common in people with RA. For added information, an analysis of joint fluid (synovial fluid) may be performed. In addition, your doctor may also order antinuclear antibody (ANA) testing. A negative ANA helps exclude SLE and other systemic rheumatic diseases; the ANA may be positive in up to one-third of patients with RA.

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Article Sources

NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

(Updated 2011 September). Questions and Answers about Arthritis and Rheumatic Diseases. National Institute of Arthritis and Musculoskeletal and Skin Diseases [On-line information]. Available online at http://www.niams.nih.gov/Health_Info/Arthritis/arthritis_rheumatic_qa.asp through http://www.niams.nih.gov. Accessed January 2012.

(August 1, 2011) Center for Disease Control and Prevention. Rheumatoid Arthritis. Available online at http://www.cdc.gov/arthritis/basics/rheumatoid.htm through http://www.cdc.gov. Accessed February 2012.

(Updated December 2011) American College of Rheumatology. Rheumatoid Arthritis, Who gets rheumatoid arthritis? Available online at http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/ra.asp through http://www.rheumatology.org. Accessed March 2012.

Check, W. (2003 June). Assay takes arthritis out of the gray zone. College of American Pathologists, Feature Story [On-line journal]. Available online at http://www.cap.org/apps/docs/cap_today/feature_stories/rheumarthritis_assay.html through http://www.cap.org.

Wiik, A., et. al. (2003). The Use of Anti-cyclic Citrullinated Peptide (anti-CCP) Antibodies in RA. American College of Rheumatology, Hotline [On-line article]. Available online at http://www.rheumatology.org/publications/hotline/1003anticcp.asp through http://www.rheumatology.org.

McCoy, T. (2003 October 24). Simple Blood Test May Predict The Development Of Rheumatoid Arthritis In Patients With Joint Pain. American College of Rheumatology, Arthritis News [On-line press release]. Available online at http://www.rheumatology.org/press/2003/pr1.asp through http://www.rheumatology.org.

Douglas, D. (2004 September 21). Antibodies Predict Course of Early Arthritis. MedlinePlus Health Information from Reuters [On-line news, not available after 10/21/2004]. Available online at http://www.nlm.nih.gov/medlineplus/news/fullstory_20221.html through http://www.nlm.nih.gov.

Kelly, J. (2005 February 25). Anti-CCP plus RF may help find patients in the "treatment-window" stage of early RA. Medscape Medical News [On-line information]. Available online at http://www.medscape.com/viewarticle/538139 through http://www.medscape.com. Accessed on 8-26-08.

Emery, P. et. al. (2008 May 12). Clinical Identification and Treatment of a Rapidly Progressing Disease State in Patients With Rheumatoid Arthritis. Medscape from Rheumatology. 2008;47(4):392-398 [On-line information]. Available online at http://www.medscape.com/viewarticle/573156 through http://www.medscape.com. Accessed on 8-26-08.

Fox, D. (2008 July 30). The ACR-EULAR Collaboration: An Expert Interview With David A. Fox, MD. Medscape Rheumatology [On-line information]. Available online at http://www.medscape.com/viewarticle/577523 through http://www.medscape.com. Accessed on 8-26-08.

Niemeier, L. (2008 March 3). The Role of Anti-CCP in the Laboratory Diagnosis of Rheumatoid Arthritis. CAP Newspath [On-line information]. Available online through http://www.cap.org. Accessed on 8-26-08.

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This article was last reviewed on April 9, 2012. | This article was last modified on April 9, 2012.

The review date indicates when the article was last reviewed from beginning to end to ensure that it reflects the most current science. A review may not require any modifications to the article, so the two dates may not always agree.

The modified date indicates that one or more changes were made to the article. Such changes may or may not result from a full review of the article, so the two dates may not always agree.